Picot Question
For Nurses and Medical Assistants in OB office (P), does education sessions on early signs of pregnancy-induced hypertension (I), comparing the knowledge gained from pretest to posttest after the sessions (C), improve early detention of pregnancy-induced hypertension and reduce complications in pregnant patients (O), in a ten weeks period? (T).
Introduction to the Topic
Pregnancy exposes women to a number of diseases that do not necessarily occur when they are not pregnant. Among the major causes of complications during pregnancy is a hypertensive pregnancy disorder that covers a spectrum of conditions and accounts for about 10% of pregnancy complications worldwide (Gaikwad et al., 2017). Pregnancy-induced hypertension, which is the most significant in the spectrum, occurs in about 6-8 % of all pregnancies in the United States (Ananth et al., 2019). This condition contributes significantly to perinatal and maternal mortality and morbidity. Most of the existing recommendations for managing and treating pregnancy-induced hypertension are based on expert opinion as well as observational studies.
However, these approaches lack research-based evidence from clinical trials. It is worth noting that the overall strategy in the treatment of pregnancy-induced hypertension is to prevent maternal cardiac complications and cerebrovascular complications while preserving the fetal and uteroplacental circulation and limiting toxicity to the fetus due to the medical intervention. In improving the outcomes of treatment, a number of interventions targeting the skills of the professionals in the OB office have been suggested. Among these methods include those aiming to improve the ability of the professions to detect early signs of pregnancy-induced hypertension and compare the knowledge gained from pretest to posttest after the sessions. However, there is little evidence from research to determine which of these two methods is more effective than the other in improving the outcomes in terms of reduction of the complications of pregnancy-induced hypertension.
Additionally, the topic of pregnancy-induced hypertension is a topic that can be studied from the perspective of midwifery and post-natal care. Midwives and occasionally doulas are well acquainted with the risks and symptoms of the disease and trained to accommodate the child and the mother as much as possible. They, therefore, can be considered to be a part of the research demographic on the matter.
Purpose and Rationale
Therefore, the purpose of this research was to determine the effectiveness of providing professionals in the OB office with education sessions in early signs of pregnancy-induced hypertension in improving early detection of the condition and reducing complications in pregnant patients. To achieve this objective, the research rationale was to compare the effects of this intervention with the outcomes of another method- the use of knowledge gained from posttest and after the sessions.
Background to the Problem and Population of Interest
Pregnancy-inducted hypertension has been found to be a major cause of complications during and after pregnancy. Indeed, studies have shown that it is one of the leading causes of mortality and morbidity in pregnant women, with about 10% of deaths resulting from complications resulting to this condition (Innes et al., 2016). Consequently, the condition is the single largest cause of maternal mortality and morbidity and the most common medical disorder during pregnancy. Nevertheless, research shows that the condition can effectively be reduced by early detection and proper management.
Significance of the Problem to Nursing and Healthcare
Nurses and other professionals working in the obstetrician (OB) and gynecologist office often face problems when dealing with complications associated with pregnancy-inducted hypertension. In fact, it requires a lot of skills, knowledge, and experience in detecting early signs of pregnancy-inducted hypertension in pregnant women to successfully prevent the complications from occurring (Lin et al., 2016). Almost all methods used in reducing the occurrence of this condition focus on the ability and knowledge of nurses and medical assistants in the OB office. The level of knowledge and expertise among these professionals ought to be excellent if the healthcare system is to achieve a significant reduction of the prevalence of pregnancy-induced mortality and morbidity.
Benefits of the Project to Nursing Practice
Once this project is completed, it is expected that it will add to the growing volume of evidence-based knowledge about the most effective methods of reducing complications associated with pregnancy-inducted hypertension. Consequently, the evidence of this research will also contribute to the available knowledge about the best practices for reducing mortality and morbidity among women during pregnancy and post-pregnancy due to the complications associated with the condition (Lin et al., 2016). Moreover, it is expected to improve the knowledge of nurses and medical assistants in the OB office of the facility about the best ways of early detection of signs of the condition and applying their skills from experience to help reduce complications.
PICOT and Scope of the Project
This study is based on the concept of PICOT, which describes the five elements of developing a good clinical question. The idea is to develop a study based on a clinical question that identifies the problem/population, intervention method, comparison, outcomes and time frame for the study. In this case, the PICOT question is âFor Nurses and Medical Assistants in OB office (Population), does education sessions in early signs of pregnancy-induced hypertension (Intervention), comparing the knowledge gained from pretest to posttest after the sessions (Comparison), improve early detention of pregnancy-induced hypertension and reduce complications in pregnant patients (Outcomes), in a 10 weeks period? (Time).
From this PICOT question, it is clear that the study will be limited to examining the medical problem of pregnancy-inducted hypertension and not any other condition. Secondly, the study will only work with nurses and medical assistants in the OB office as the population of interest from which participants will be drawn. Moreover, the research will compare only two intervention methods to determine which has the best outcomes. Finally, this research is limited to a time frame of 10 weeks.
Literature Review
Hypertension in pregnancy is a major cause of complications among pregnant women and a problem to the nursing field because of the high morbidity and mortality rates. By definition, hypertension in pregnancy is a systolic blood pressure (BP) that equal to or above 140 mm Hg and a diastolic blood pressure of 90 mm Hg and above on two separate measurements taken at least four to six hours apart (Yang et al., 2018). Measuring BP requires interpretation in the context of the stage of pregnancy for each patient as well as the expected changes in blood pressure for each of the three trimesters. Research conducted over the last few decades indicate that during the first and second trimesters, blood pressure drops significantly at around 20 weeks to gestation (Yang et al., 2018). Consequently, this should be the measurable aspects when determining the risks
In the third trimester, however, BP returns to preconception levels. Research also shows that women who did not have regular medical care before pregnancy are gestational hypertension because of elevated BPs in the third trimester when in reality, they had the condition prior to becoming pregnant. This problem is caused by masking of the condition by physiologic changes in mid-pregnancy stages (Varija et al., 2016). If a woman has gestational hypertension that fails to be resolved after delivery, she is likely to be diagnosed with chronic hypertension. Consequently, pregnancy-inducted hypertension remains a major problem in healthcare and requires adequate attention to reduce its impacts and outcomes.
The prevalence of pregnancy-inducted hypertension in the US and the world remains relatively high. In the US, surveys and other clinical studies provide evidence that the prevalence of the condition in women aged 20 to 45 is above 7.5% and sometimes reaches 10% (Varija et al., 2016). Moreover, pregnancy-induced hypertension accounts for above 10% of the total complications and deaths in pregnant women (Varija et al., 2016). Complications associated with pregnancy-induced hypertension in women include cerebrovascular complications such as seizures and cerebral hemorrhage, cardiovascular complications like deme, and renal impairment. Women who have chronic hypertension as well as those with evidence of end-organ damage before pregnancy are at a high risk of developing retinopathy, renal failure, pulmonary edema cerebral hemorrhage, and hypertensive encephalopathy.
Even though there are various non-pharmacological and pharmacological treatment methods for pregnancy-induced hypertension and associated complications, it is imperative to understand that mitigation of the risk remains is of paramount importance. The importance of early detection of pregnancy-induced hypertension in OB offices seeks to recognize and assess the progression of pregnancy and possibility of complications in order to reduce the risk of developing the condition (Friedman et al., 2018). Nurses and medical assistants in the OB office need to have adequate skills and knowledge, as well as experience, in order to develop abilities for early detection of signs associated with onset of pregnancy-induced hypertension.
Educating nurses and medical assistants in OB office on early detection is based on three main points that completed each other. First, there should be a detailed medical history and the professions must be aware of its importance. Secondly, the professions need to have adequate skills in the collection and analysis of biophysical parameters such as BP. In addition, professionals must have adequate knowledge in measuring arterial stiffness and conducting Doppler examination of blood vessels in pregnant and pre-pregnant women (Azami et al., 2018). Finally, the professionals must be able to determine biochemical parameters as they can give clues to possible impairment of placental function. Consequently, these points must dominate the education given to nurses and medical assistants working in the OB office.
Knowledge gained from pretest to posttest after the attending or participating in training sessions can play an important role in providing professionals with adequate knowledge to deal with the situation. This intervention aims at using active learning strategies such as engaging students in activities that involve more than passive listening and emphasis on developing learnersâ skills (Bernstein et al., 2017). Immediate feedback from the instructor is provided to the students as a way of engaging them in high order thinking such as synthesis, analysis, and evaluation.
Nurses require continuous or ongoing improvements to meet the changing demands of the practice. Studies have shown that if this approach is used to provide nurses and medical assistants in the OB office with more skills and knowledge about pregnancy-induced hypertension, then the outcomes improve since prevalence and mortality rates associated with the condition reduce significantly. Hence, this intervention method is applicable and comparable to others in examining the best method for improve early detention of pregnancy-induced hypertension and reduce complications in pregnant patients.
Methods
Overview of Methods
This story seeks to conduct a comparison between the effects of two intervention methods used to improve early detention of pregnancy-induced hypertension and reduce complications in pregnant patients. Both methods focus on providing education to nurses and medical assistants working in the OB office. The specific instructions provided to the students involve giving them skills and knowledge that will help them improve early detention of pregnancy-induced hypertension and reduce complications in pregnant patients. Consequently, the study needs to have two groups of participants in place. The first group will form the main study group or the test group and will be exposed to education sessions in early signs of pregnancy-induced hypertension. In essence, they will attend instructional sessions in early signs of pregnancy-inducted hypertension, which will be under a professor of nursing and expert in the OB-GYN field of medical specialization.
On the contrary, the second group, which is the control group, will be exposed to an instructional method in which they will gain knowledge from pretest to posttest after the sessions. The rationale for this control group is to provide them continuous or ongoing improvements to meet the changing demands of the practice. Studies have shown that if this approach is used to provide nurses and medical assistants in the OB office with more skills and knowledge about pregnancy-induced hypertension, then the outcomes improve since prevalence and mortality rates associated with the condition reduce significantly.
To conduct the grouping and satisfy the required research criteria, the candidatesâ diagnosis for pregnancy-induced hypertension will be verified. Additionally, the advanced screening for the potential participants will be conducted in accordance with the existing statistics for the diagnosis. Generally, patients aged 35 or older are over five times more likely than younger women to develop PIH (p = 0.0024). Nullips have a lower risk of PIH, with the link being statistically significant (OR 0.31, p = 0.0454). Additionally, those who had previously experienced PIH were 6.85 times more likely to experience PIH during this pregnancy than those who had not previously experienced PIH (p = 0.0000). It is, therefore, reasonable to conclude that the diagnosis involves a self-perpetuating risk group with the high chances of repeated occurrences. To achieve measurable research progress, the scientists would need to monitor the awareness of the previous cases of PIH if any are present.
Overview of the Approach/Design
Both groups of participants will be provided education concurrently but in separate setting within the same hospital. The idea is to give the nurses and medical assistants educational sessions about early signs of pregnancy induce hypertension. Before the educational sessions, the instructors provided the participants with a pretest to measure the knowledge about the disease, and after the intervention a posttest was done to the participants to measure the knowledge about the disease. After 10 weeks, the rate of pregnancy induce hypertension was measured in the OB office due to the identification of early signs by nurses and medical assistants and implementation of prevention and health promotion following the training sessions. Consequently, the data collection was based on the rates of pregnancy-inducted hypotension among women in the ward handled by the first group and the second groups separately. A comparison of the two rates will be the data analysis and will test the study question.
The overall sample size was proportionately distributed among the three public hospitals based on their respective source populations. Each hospital’s source population was derived from six-month delivery records. The research participants were methodically chosen from each hospital, and all eligible moms who were hospitalized for delivery were included in the study.
Site and Participant Information
The study will take place in a hospital setting that has an OB-GYN office. Therefore, the specific study site is an OB office within a hospital where reproductive health is provided to the community. Permission to conduct the study, therefore, will be obtained from the hospital management. Secondly, the participants will be nurses and medical assistants working in the OB office and who have at least one year of experience working with pregnant women, including participating in pregnancy service provision, delivery, and after-delivery care. Both males and females are included in the participants and any other social and demographic differences are ignored. All participants will have a good level of English since the instructions will be given in this language. Moreover, all participants will be full-time employees of the hospitalâs OB office.
Methods
The first step will be to seek approval from the Universityâs relevant board that approves research work to be conducted. A research proposal will be developed and presented to the board and upon approval, a request for permission will be sent to the hospital management. Once approved, the second step will be to develop the curriculum that will be used to educate the participants. The participants will be sent consent forms asking them to join the research as the study subjects but on their own will. Two professors will handle the classes or sessions and will provide the instructions. The entire process will take 10 weeks after which data collection will start. Data collection will take place in the separate settings where pregnant women attend for services, both in-patient and those already admitted. Specifically, the researcher will work with the hospital OB office to collect data on the prevalence of pregnancy-induced hypertension among women in the facility. Data on the prevalence of the disease among those handled by the test group of participants will be separate from that handled by the control group. Moreover, data will be collected for a period of 12 months starting at the point the participants start working after attending education sessions.
Specifics of the Methods
Instruments
Tests will be used in the study as instruments for testing the knowledge of the control group. The aim of this is to examine and evaluate the knowledge gained from pretest to posttest after the sessions. These tests will be standardized and will have questions relating to the instructions given throughout the session. The idea is to evaluate the progress of the sessions as the classes continue. Such tests are known to have a high level of reliability and validity, given that they are predetermined set of questions used to collect data about a given issue of interest (Rae et al., 2018). They also provide feedback to the instructor through measuring the initial level of knowledge and the knowledge gained from the learning session or workshop. Consequently, the data gained from this instrument will be used to ascertain and evaluate the final outcomes in terms of prevalence of the disease among patients handled by this group of participants.
Data collection
The research will use quantitative data, given that the prevalence of the disease needs to be in figures and numbers. This data is measurable and will be in form of number of women developing the disease within the 12-month study period. In addition, it will include the number of recoveries, complicated cases, and deaths, referrals to specialized treatment, and comparison with the total population of pregnant women seeking help.
Data analysis
Statistical approach to data analysis will be applied in the study and will involve measures of central tendency for each set of participants. Then, there will be correlation tests with specialized data analysis tool and techniques. In this case, the idea is to develop a strategy for comparing the results of the outcomes for each set of data and then compare between the sets. The prevalence of the disease as well as other aspects such as recovery rates, death rates, and others will be compared between the two data sets. In this case, the idea is to use Excel and SPSS software systems to achieve these objectives as they are powerful tools for data analysis.
The scientifically appropriate data analysis of the quantitative findings of the research might be pointed out as another measurable outcome of the project. Quantitative data is numerical by definition. This means you may collect percentages and statistics and use graphs and charts to analyze your findings. Quantitative data is less prone to bias and may frequently be extended to match a larger sample size than the data was taken from. However, it is also more difficult to interpret in-context and to elaborate upon due to the less descriptive nature of quantitative statistics. Therefore, the researchers are expected to fill in the gaps on the foundation of the conducted literature review.
References
Ananth, C. V., Duzyj, C. M., Yadava, S., Schwebel, M., Tita, A. T., & Joseph, K. S. (2019). Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension, 74(5), 1089-1095.
Gaikwad, K. B., Joshi, N. G., & Selkar, S. P. (2017). Study of nitrosative stress in âPregnancy Induced Hypertensionâ. Journal of clinical and diagnostic research: JCDR, 11(3), BC06.
Innes, K. E., Kandati, S., Flack, K. L., Agarwal, P., & Selfe, T. K. (2016). The relationship of restless legs syndrome to history of pregnancy-induced hypertension. Journal of Women’s Health, 25(4), 397-408.
Yang, C. C., Tang, P. L., Liu, P. Y., Huang, W. C., Chen, Y. Y., Wang, H. P.,… & Lin, L. T. (2018). Maternal pregnancy-induced hypertension increases subsequent neonatal necrotizing enterocolitis risk: A nationwide population-based retrospective cohort study in Taiwan. Medicine, 97(31).
Lin, L. T., Tsui, K. H., Cheng, J. T., Cheng, J. S., Huang, W. C., Liou, W. S., & Tang, P. L. (2016). Increased risk of intracranial hemorrhage in patients with pregnancy-induced hypertension: A nationwide population-based retrospective cohort study. Medicine, 95(20).
Varija, T., Vanaja, D., & Bellara, R. (2016). A study of prevalence and association of fundus changes in pregnancy induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(5), 1375-1380.
Bernstein, P. S., Martin, J. N., Barton, J. R., Shields, L. E., Druzin, M. L., Scavone, B. M.,… & Menard, M. K. (2017). National partnership for maternal safety: consensus bundle on severe hypertension during pregnancy and the postpartum period. Anesthesia & Analgesia, 125(2), 540-547.
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research, 2018.
Friedman, A. M., Campbell, M. L., Kline, C. R., Wiesner, S., D’Alton, M. E., & Shields, L. E. (2018). Implementing obstetric early warning systems. American Journal of Perinatology Reports, 8(02), e79-e84.
Rae, J. R., & Olson, K. R. (2018). Testâretest reliability and predictive validity of the Implicit Association Test in children. Developmental psychology, 54(2), 308.